Organization
SOUTH FULTON FAMILY FOOT CARE, INC.
Active
Organization
SOUTH FULTON FAMILY FOOT CARE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RONA RENELL GREEN DPM (CEO)
(770) 964-2201
Entity
Organization
Contact information
Practice address
67 W CAMPBELLTON ST, FAIRBURN, GA 30213-1338
(770) 964-2201
(770) 306-9744
Mailing address
PO BOX 188, FAIRBURN, GA 30213-0188
(770) 964-2201
(770) 306-9744
Taxonomy
Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
Primary
697
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4355747
GA AETNA PPO NUMBER
GA
01
—
451998
GA BCBS NUMBER
GA
01
—
697
GA STATE LICENSE NUMBER
GA
Enumeration date
05/13/2007
Last updated
04/20/2008
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